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General NPI Number Information
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NPI Number | 1144678459
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Entity Type | Organization
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Legal Business Name | BAYVIEW EYECARE PS
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 2217 N 30TH ST STE 106
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City | TACOMA
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State | WA
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Zip | 98403-3320
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Country | US
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Telephone | 253-627-2818
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Fax | 253-627-1901
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Provider Business Mailing Address
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Address Line | 2217 N 30TH ST STE 106
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City | TACOMA
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State | WA
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Zip | 98403-3320
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Country | US
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Telephone | 253-627-2818
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Fax | 253-627-1901
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN M GORNY
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Credential | O.D.
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Telephone | 253-627-2818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 603619140
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License Number State | WA
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